Basic Information
| Provider Information | |||||||||
| NPI: | 1053456806 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | RAMIREZ | ||||||||
| FirstName: | IVAN | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1867 E FIR AVE | ||||||||
| Address2: | SUITE 104 | ||||||||
| City: | FRESNO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 937203808 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5593255800 | ||||||||
| FaxNumber: | 5593255838 | ||||||||
| Practice Location | |||||||||
| Address1: | 1867 E FIR AVE | ||||||||
| Address2: | SUITE 104 | ||||||||
| City: | FRESNO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 937203808 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5593255800 | ||||||||
| FaxNumber: | 5593255838 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/20/2007 | ||||||||
| LastUpdateDate: | 06/28/2008 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0202X | 01063009A | IN | N | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology | 2085R0202X | A102748 | CA | Y | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
No ID Information.